PANADOL TABLETS PANADOL MINI CAPS DATA SHEET Proprietary (Trade) Name: PANADOL Active ingredient: Paracetamol (BP) 500 mg/tablet PRESENTATIONS White, film-coated tablet with bevelled edge, shallow convex, double radius 1.27 cm diameter. Marked PANADOL on one side and with a break bar on the reverse side. Capsule shaped tablet with a gelatin coating which is one half green and the other half white. INDICATIONS For fast effective temporary relief of pain and discomfort associated with headache, muscular aches, period pain, arthritis/osteoarthritis, toothache, migraine, cold & flu symptoms, tension headache, sinus pain/headache and backache. Reduces fever. DOSAGE AND ADMINISTRATION Adults and children aged 12 years and over: 1 to 2 tablets every four to six hours as required. Maximum of 8 tablets in 24 hours. Do not use for more than a few days at a time in adults without medical advice. Children 7 to 12 years: ½ to 1 tablet every four to six hours as required. Maximum of 4 tablets in 24 hours. Should not be used for more than 48 hours for children 7 17 except on medical advice. Mini Caps Adults and children aged 12 years and over: 1 to 2 mini caps every four to six hours as required. Maximum of 8 mini caps in 24 hours. PANADOL IMMEDIATE RELEASE Data Sheet Page 1 of 7
Do not use for more than a few days at a time in adults without medical advice. Children 7 to 12 years: 1 mini caps every four to six hours as required. Maximum of 4 mini caps in 24 hours. Should not be used for more than 48 hours for children 7 17 except on medical advice. Children under 7 years: Not recommended for children under the age of 7 years. Take with water or other fluid. Do not exceed the stated dose. The lowest dose necessary to achieve efficacy should be used. Should not be used with other paracetamol-containing products. Minimum dosing interval: 4 hours. Renal and Hepatic impairment Patients who have been diagnosed with liver or kidney impairment must seek medical advice before taking this medication. (See WARNINGS AND PRECAUTIONS.) CONTRAINDICATIONS These products are contraindicated in patients with a previous history of hypersensitivity to paracetamol or any of the excipients. WARNINGS AND PRECAUTIONS Contains paracetamol. Do not use with any other paracetamol- containing products. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Paracetamol should be used with caution in patients with: Impaired liver function: Underlying liver disease increases the risk of paracetamol-related liver damage Impaired kidney function: Administration of paracetamol to patients with moderate to severe renal impairment may result in accumulation of paracetamol conjugates. PANADOL IMMEDIATE RELEASE Data Sheet Page 2 of 7
Patients who have been diagnosed with liver or kidney impairment must seek medical advice before taking this medication. Cases of hepatic dysfunction/failure have been reported in patients with depleted glutathione levels, such as those who are severely malnourished, anorexic, have a low body mass index or are chronic heavy users of alcohol. In patients with glutathione depleted states such as sepsis, the use of paracetamol may increase the risk of metabolic acidosis. If symptoms persist, medical advice must be sought. Keep out of sight and reach of children. Use in pregnancy Category A Paracetamol has been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed. Paracetamol crosses the placental barrier. Animal studies with paracetamol have not identified any risk to pregnancy or embryo-foetal development. Use in lactation Paracetamol is excreted in breast milk. Human studies with paracetamol have not identified any risk to lactation or the breast-fed offspring. Use in children Not recommended for children under seven years of age. Effects on ability to drive and use machines Paracetamol is unlikely to cause an effect on the ability to drive or use machinery. Other Pre-clinical Preclinical safety data on paracetamol in the literature have not revealed findings that are of relevance to the recommended dosage and use of the product. ADVERSE EFFECTS Adverse events from historical clinical trial data are both infrequent and from small patient exposure. Accordingly, events reported from extensive post-marketing experience at therapeutic/labelled dose and considered attributable are tabulated below by System Organ Class and frequency. PANADOL IMMEDIATE RELEASE Data Sheet Page 3 of 7
The following convention has been utilised for the classification of undesirable effects: very common ( 1/10), common ( 1/100, <1/10), uncommon ( 1/1,000, <1/100), rare ( 1/10,000, <1/1,000), very rare (<1/10,000), not known (cannot be estimated from available data). Adverse event frequencies have been estimated from spontaneous reports received through post-marketing data. Body System Undesirable Effect Frequency Blood and lymphatic system disorders Thrombocytopenia Very rare Immune system disorders Anaphylaxis Very rare Cutaneous hypersensitivity reactions including, among others, skin rashes, angioedema, Stevens Johnson syndrome and Toxic Epidermal Necrolysis Respiratory, thoracic and Bronchospasm, especially in patients Very rare mediastinal disorders sensitive to aspirin and other NSAIDs Hepatobiliary disorders Hepatic dysfunction Very rare INTERACTIONS The following interactions with paracetamol have been noted: The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increased risk of bleeding. Anticoagulant dosage may require reduction if PANADOL medication is prolonged. Paracetamol absorption is increased by substances that increase gastric emptying, eg metoclopramide. Paracetamol absorption is decreased by substances that decrease gastric emptying, eg propantheline, antidepressants with anticholinergic properties and narcotic analgesics. Paracetamol may increase chloramphenicol concentrations. The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes such as alcohol and anticonvulsant drugs. Paracetamol excretion may be affected and plasma concentrations altered when given with probenecid. Colestyramine reduces the absorption of paracetamol if given within one hour of paracetamol. PANADOL IMMEDIATE RELEASE Data Sheet Page 4 of 7
OVERDOSE Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Acute pancreatitis has been observed with hepatic dysfunction. Treatment Immediate medical management is required in the event of an overdose, even if the symptoms of overdose are not present. If an overdose is taken or suspected, contact the Poisons Information Centre immediately for advice ((0800 764 766), or the patient should go to the nearest hospital straight away. This should be done even if they feel well because of the risk of delayed, serious liver damage. (See ADVERSE EFFECTS.) Administration of N-acetylcysteine may be required. In cooperative adults, activated charcoal may reduce absorption of the medicine if given within one hour after ingestion. FURTHER INFORMATION Actions Paracetamol is a para-aminophenol derivative that exhibits analgesic and anti pyretic activity. Its mechanism of action is believed to include inhibition of prostaglandin synthesis, primarily within the central nervous system. It is given by mouth or rectally (suppositories) for mild to moderate pain and fever. Pharmacodynamics The lack of peripheral prostaglandin inhibition confers important pharmacological properties such as the maintenance of the protective prostaglandins within the gastrointestinal tract. Paracetamol is, therefore, particularly suitable for patients with a history of disease or on concomitant medication, where peripheral prostaglandin inhibition would be undesirable (such as, for example, those with a history of gastrointestinal bleeding or the elderly). Pharmacokinetics Absorption Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Food intake delays paracetamol absorption. Distribution Paracetamol is distributed into most body tissues. Binding to the plasma proteins is minimal at therapeutic concentrations but increases with increasing doses. Metabolism Paracetamol is metabolised in the liver and excreted in the urine mainly as glucuronide and sulphate conjugates. PANADOL IMMEDIATE RELEASE Data Sheet Page 5 of 7
The metabolites of paracetamol include a minor hydroxylated intermediate which has hepatotoxic activity. This intermediate metabolite is detoxified by conjugation with glutathione. However, it can accumulate following paracetamol overdosage (more than 200 mg/kg or 10 g total paracetamol ingested) and, if left untreated, can cause irreversible liver damage. Paracetamol is metabolised differently by infants and children compared to adults, the sulphate conjugate being predominant. Excretion Paracetamol is excreted in the urine mainly as the glucuronide and sulphate conjugates. Less than 5% is excreted as unmodified paracetamol with 85% to 90% of the administered dose eliminated in the urine within 24 hours of ingestion. The elimination half-life varies from one to three hours. Chemical structure: Excipients: Pregelatinised maize starch, Maize starch, Purified talc, Stearic acid, Hypromellose, Povidone, Triacetin, Potassium sorbate, Carnauba wax. Gelatin, Pregelatinised maize starch, Croscarmellose sodium, Povidone, Stearic acid, Hypromellose, Titanium dioxide, Quinoline yellow, Brilliant blue FCF, Allura red AC. PHARMACEUTICAL PRECAUTIONS Shelf life 48 months from date of manufacture. 36 months from date of manufacture. Special Conditions for Storage Store below 30ºC. PANADOL IMMEDIATE RELEASE Data Sheet Page 6 of 7
Store below 25ºC. PACKAGE QUANTITIES Blister packs of 2, 12, 20, 50, 100, 120, 150 and 1000 tablets. Blister packs of 12, 20 and 48 Mini Caps. MEDICINE SCHEDULE Packs of under 20 General sale Packs of 20 and more Pharmacy only SPONSOR DETAILS GlaxoSmithKline Consumer Healthcare, 11th Floor, Zurich House, 21 Queen St Auckland, New Zealand DATE OF PREPARATION 15 DEC 2016 PANADOL is a registered trade mark of the GSK group of companies or its licensor. PANADOL IMMEDIATE RELEASE Data Sheet Page 7 of 7